Athletics.westmoreland.edu



Dear Westmoreland County Community College Student-Athlete:For the 2021-2022 academic year, Westmoreland County Community College will provide intercollegiate athletic insurance for you under the following guidelines:If you or your parents have medical insurance, that medical insurance will be the primary coverage for the treatment.Whatever costs your insurance plan will not cover may be covered by the Westmoreland intercollegiate athletic insurance plan.If you do not have any medical insurance coverage, the Westmoreland intercollegiate athletic insurance plan may cover the cost of any injuries.The athletic insurance plan utilizes a health provider network. If you go out of the health provider network, you will be responsible for any charges not covered by the athletic insurance plan. The current provider is First Health (Coventry). A list of in-network providers can be found at .All claims must be submitted to Sue Barron, Administrative Services, within 90 days from the date of injury. Claim forms are available from the head athletic trainer.Please sign the bottom of this form indicating that you understand the above guidelines. Indicate the name of your insurance company and the policy numbers that you will be using.Sincerely,Michael DraghiInterim Director of Athletics and RecreationStudent / Athlete Name (Please Print): Insurance Company: Policy Number(s): WESTMORELAND COUNTY COMMUNITY COLLEGEACCEPTANCE OF RISK / LIABILITY WAIVER AFFIDAVITI, ___________________________________ (Athlete’s Name)Understand that having passed the physical examination does not necessarily mean that I am physically qualified to engage in athletics, but only that the examiner did not find a medical reason to disqualify me.Understand that I must refrain from practices or games during medical treatment until I am discharged from treatment by a physician or the athletic trainer.Understand and accept the risks of injury, permanent disability, and death that are inherent in their sport. By signing below, I pledge to do the best to reduce these risks by keeping in the best possible condition and following the advice of the team, athletic trainer, and / or coach concerning the prevention, treatment, and rehabilitation of athletic injuries.Grant permission to the athletic trainer to hospitalize and secure treatment for myself for any athletic injuries. If the athlete is a minor, the undersigned parent grants permission to the athletic trainer to hospitalize and secure treatment for my son / daughter.An Incident Report should be completed ASAP after an injury and needs completed by the student, athletic trainer, and the director of athletics.Understand that while participating in practice or games, I may incur a career ending injury or death by participating on the intercollegiate athletic team.We, the undersigned, have read and understand the preceding Acceptance of Risk / Liability Waiver Affidavit and agree to its procedures.(Athlete’s Signature)(Parent’s / Guardian’s Signature)(Date)(Date)WESTMORELAND COUNTY COMMUNITY COLLEGEStudent Athlete Code of ConductPLEASE READ THE FOLLOWING MATERIAL CAREFULLY AND RETURN THE SIGNED FORM TO YOUR TEAM HEAD COACHParticipation in Westmoreland County Community College’s intercollegiate athletics program is a privilege and not a right. For the purpose of this document, student athlete refers to any student who desires to participate as a player or other member, i.e. student trainer, etc., of Westmoreland’s intercollegiate athletic team program. Student team members agree to certain responsibilities. The college places expectations on team members and reserves the right to limit participation based on academic standing and / or noncompliance with NJCAA / Region XX / WPCC rules and regulations and / or Westmoreland‘s policies and procedures.Student Athlete ResponsibilitiesCompletely read and understand all college policies as outlined in the current annual catalog, including:a)Student Athlete Eligibilityd)Student Rights and Responsibilitiesb)Student Conduct Codee)Drug and Alcohol Policyc)Sexual Harassment PolicyUnderstand that any violation of the above policies may be grounds for dismissal from athletic participation as well as from the college. Acts of misconduct include, but are not limited to:Use, possession, or distribution of alcoholic beverages;Use, possession, or distribution of narcotics / controlled substances except as expressly permitted by law;Possession of firearms, explosives, or dangerous chemicals or other dangerous devices;Hazing of fellow athletes as defined by: doing any act or causing any situation, which recklessly or intentionally subjects a student to the risk of serious bodily injury or emotional harm.Review current NJCAA / Region XX / WPCC Eligibility Rules and Bylaws as they pertain to student athletes.Stipulate that athletes ejected from a contest for any reason will not be allowed to participate in the next regularly scheduled contest in that sport. If the ejection reason were fighting, that athlete would not be allowed to participate in the next two regularly scheduled contests.In incidents of ejection, the Director of Athletics will meet with the individual(s) and the team to review Westmoreland’s commitment to proper sportsmanship.A second offense for fighting will not be tolerated and shall be grounds for dismissal from the team.Westmoreland shall review each incident and determine if additional internal sanctions will be placed upon the individual(s) involved.Use college-provided transportation to and from all scheduled athletic contests unless written permission has been obtained from the director of athletics prior to the scheduled contest.Agree to pay any and all associated fees for missing or damaged (less normal wear) Westmoreland issued team uniforms, practice uniforms and / or equipment that is not returned to the athletic department at the end of the season.Behave in accordance with accepted standards, respect the rights of others, refrain from conduct or activity, which obstructs the work of the college and / or is damaging to the welfare of the community or the college.Read, sign and return the Risk Liability Waiver Form to the athletic department prior to participating in intercollegiate athletics.Authorize the college to release the use of the student-athlete’s pictures, schedule, and transcript information to coaches, the WPCC / Region XX / NJCAA / NAIA, NCAA and media services.With my signature below I agree, acknowledge, and accept the responsibilities stated above and understand that Westmoreland reserves the right to remove me from any and all participation in the intercollegiate athletic team program.(Athlete’s Printed Name)DateSport(Athlete’s Signature)(Parent / Guardian’s Signature, required if athlete is under the age of 18)left-11254200NJCAA ELIGIBILITY AFFIDAVIT Fill in all applicable information on this form to assist in determining eligibility for the NJCAA.Sport(s):Today’s Date://Name:Birth Date:// (First, Middle, Last)Personal InformationCell Phone Number:Home Phone Number:Parents’ Name:Email Address:Home Address: (Street Address, Apt. Number, PO Box) (City, State, Zip Code)Are you a United States Citizen?YesNoAre you a Permanent Resident?YesNo* Are you on another type of VISA?Yes No *If so, what type?HIGH SCHOOL INFORMATIONHigh School(s) Attended:Cities, States, Counties:* Graduated?YesNoHigh School Graduation (month/year):/Check here if you have earned a *GED * Enclose a COPY of your high school diploma or GED certificate, high school transcript or Home School records.ADDITIONAL INFORMATION1.Did you take any college credit classes while in high school? YesNo* if yes, from what college(s)? * if yes, please furnish transcript(s) from each college2.Have you ever signed a Letter of Intent form with any institution?YesNoIf yes, specify the college:Date (day/month/year)://3.Have you ever participated in a sport in a country other than the United States?YesNoIf yes, describe the situation and complete the following:Sport(s):Country:Dates:4.Have you ever been red-shirted for a season?YesNoIf yes, list when, where, and describe the situation:(Please continue on to the next page)5.Have you ever participated in practices / tryouts / exhibitions / scrimmages / games for an intercollegiate team other than this college?YesNoIf yes, name the school, date, sport, and describe the situation:6.Have you ever played on a club team at a college or university?YesNoIf yes, name the school, sport, and the dates:7.Have you ever received money beyond expenses for participating in any athletic event?YesNoIf so, describe the situation:List ALL Colleges Attended Full-Time and/or Part-Time After High SchoolAll transcripts from all previous institutions must be includedCollege:Date:Full-TimeorPart-TimeCollege:Date:Full-TimeorPart-TimeCollege:Date:Full-TimeorPart-TimeCollege:Date:Full-TimeorPart-TimeADDITIONAL EXPLANATIONSNOTE: If you attended college part-time or were not attending at all for any periods of time following high school graduation, please document your employment and military history during those times. If you were unemployed at any time, please list those dates as well. The NJCAA requires that we account for any time not enrolled full-time. Please use the space below. Please record months and years when referring to dates. Use an additional sheet of paper if needed.(NJCAA Eligibility Affidavit Continued)CERTIFICATION: I certify that:I will abide by all the rules for the athletic eligibility established by the NJCAA and Westmoreland College.I am enrolled as a full-time undergraduate student in good academic standing.I will be continuously enrolled in at least 12 credits of college work during each semester while competing in athletics.I will maintain satisfactory academic progress.I will maintain at least a 1.75 cumulative grade point average as a first-year participant.I will maintain at least a 2.0 cumulative grade point average as a second-year participant.I must provide proof of high school graduation.I must provide a copy of all previous college transcripts.I will notify my academic advisor and / or the athletic director before making any changes that may affect my athletic eligibility.I understand that any information falsely given or concealed pertinent to my eligibility will make me ineligible for further competition in all sports and will cause my institution to forfeit any contest in which I participated.Transfers Only: I was making satisfactory academic progress at my previous institutionI give Westmoreland College Athletic Department permission to check my college records for eligibility purposes and to release information on athletic eligibility and participation to the NJCAA and other higher education institutions. The athletic department does have permission to check my academic status for the purpose of monitoring my progress, and to release individual statistics and photographs to the media.I understand that information falsified or omitted can make me ineligible for ALL future college competition in compliance with the National Junior College Athletic Association Eligibility Rules.Student-Athlete Signature:Date:Parent Signature:Date: (If student-athlete is not 18 years old)Coach Signature:Date: ................
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